[The special attention to re-admitted patients can be effective. Cost-benefit analysis of a new health care model]. / La atención especial a los pacientes reingresadores puede ser eficiente. Análisis coste-beneficio de un nuevo modelo asistencial.

BACKGROUND: Patients with chronic conditions are commonly readmitted to hospital. A study was designed to improve their medical care. The cost/benefit analysis is presented to evaluate its efficiency. PATIENTS AND METHODS: Patients attended at the Internal Medicine Department in a hospital area who were readmitted three or more times in a year were included in the study. In a prospective study, patients were attended by means of a specific consultation with upon request care or through telephone care, with the possibility of elective admission. A comparison was made of costs of the new care program with costs of their usual care, and it was correlated with attending results. RESULTS: Patients were followed for 32 months with a 45% decrease in admissions, 50% in visits to the Emergency Department, and 26% in the hospital stay days. The new program involves monthly savings over 5 million pesetas for the attended population. CONCLUSIONS: The proposed health care program decreases the attending needs in these patients and costs derived from hospital care. An efficient alternative is shown.

La atención especial a los pacientes reingresadores puede ser eficiente. Análisis coste-beneficio de un nuevo modelo asistencial / The special attention to re-admitted patients can be effective. Cost-benefit analysis of a new health care model

Fundamento. Los pacientes con patología crónica con gran frecuencia reingresan en el hospital. Se diseñó un estudio con el fin de mejorar su asistencia. Se presenta el análisis coste-beneficio para evaluar su eficiencia. Pacientes y métodos. Se incluyen los enfermos atendidos por el servicio de Medicina Interna de un área hospitalaria que reingresaron tres o más veces en un año. Dentro de un estudio prospectivo se atendieron mediante una consulta específica con atención a demanda y telefónica con la posibilidad de ingreso programado. Se hace una comparación de los costes del nuevo programa asistencial con los costes de su asistencia habitual y se correlaciona con los resultados asistenciales. Resultados. Los pacientes fueron seguidos durante 32 meses con un descenso del 45 por ciento de los ingresos, del 50 por ciento en la frecuentación al servicio de Urgencias y de un 26 por ciento de los días de estancia hospitalaria. El nuevo programa supone un ahorro mensual de más de 5 millones de pesetas para esa población asistida. Conclusiones. El modelo asistencial propuesto disminuye las necesidades asistenciales de estos pacientes y los costes de su asistencia hospitalaria. Se muestra una alternativa eficiente (AU)

[A new model for medical care to multi-admitted patients]. / Un nuevo modelo para la asistencia a los pacientes multiingresadores.

BACKGROUND AND OBJECTIVE: Patients with chronic conditions are often readmitted to hospital. A study was designed to improve health care to these patients. PATIENTS AND METHODS: Patients attended at the Internal Medicine Department of a hospital area who were admitted to hospital at least three times in a year were included in the study. Within a prospective study, patients were attended by means of specific consultation with care upon request and telephone care, with the possibility of programmed admission. RESULTS: Patients were followed for 32 months, with a 45% decrease in the admission rate, 50% in visits to the Emergency Department, and 26% in hospital stay days. CONCLUSIONS: The proposed care model decrease the attending needs for these patients.

Un nuevo modelo para la asistencia a los pacientes multiingresadores / A new model for medical care to multi-admitted patients

Fundamento. Los pacientes con patología crónica con gran frecuencia reingresan en el hospital. Se diseñó un estudio con el fin de mejorar su asistencia. Pacientes y métodos. Se incluyen los enfermos atendidos por el Servicio de Medicina Interna de un área hospitalaria que reingresaron tres o más veces en un año. Dentro de un estudio prospectivo se atendieron mediante una consulta específica con atención a demanda y atención telefónica, con la posibilidad de ingreso programado. Resultados. Los pacientes fueron seguidos durante 32 meses, con un descenso del 45 por ciento de los ingresos, del 50 por ciento en la frecuentación al Servicio de Urgencias y de un 26 por ciento de los días de estancia hospitalaria. Conclusiones. El modelo asistencial propuesto disminuye las necesidades asistenciales de estos pacientes. (AU)

[Tuberculosis in 7 general hospitals in Andalusia. Grupo Andaluz para el Estudio de las Enfermedades Infecciosas]. / La tuberculosis en 7 hospitales generales de Andalucía. Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

BACKGROUND: To know the clinical features of tuberculosis in our environment, to evaluate its diagnostic techniques and therapeutic options as well as the evolution of patients. PATIENTS AND METHODS: Multicenter retrospective study of 1115 patients with tuberculosis, diagnosed between 1984 and 1988 in the population based areas of 7 Hospitals from Andalusia (Spain). RESULTS: The mean age was less than 40 ages, the exponential growing of the number of cases a year in which the influence of drug addicts could be an important factor, an elevated proportion (45%) of extrapulmonary tuberculosis and disseminated forms, and a social environment of 20% of cases being alcoholics or drug addicts. A good use of diagnostic techniques is recorded, although the use of culture as diagnostic tools is lacking. The usual treatment was three drugs for nine months. The global evolution seems good. However a global mortality of 6.4% is recorded, mainly in disseminated forms and among patients with risk factors for developing tuberculosis. SUMMARY: We have seen an increment among tuberculosis cases, as well as a change in the clinical spectrum of the disease, linked to social illness and drug addiction. The diagnostic approach to tuberculosis seems to be appropriate. The follow up of patients is somewhat confusing.